All Star Volleyball Club’s clinic for Boys & Girls

                                    Cost: $50.00          (Scholarships available)               

*Ages: 14-17 1/2        * Both Girls & Boys       * Beginning or Advanced

Registration: 12-1:00 July 26

Skills & Drill: 1-4:00 July 27

Skills & Drill: 1-4:00 July 28

Final Play 1-4:00 July 29

Child’s Name: ________________________________________

Gender: _____________Age:__________ Beginning or Advanced:______________________

Parent /Guardian Name: ____________________________________________________

Address: _______________________________________________________________

Email address: __________________________________________________________

Phone number: _____________________________________________________________

Medical insurance company: ______________________Policy #:________________________________

BY signing this form, you are releasing all claims I and/or the participating may sustain. I agree to assume full risk and to waive and release all claims I and/or the participant may have against ALL STAR SPORTS ARENA. This release also includes ASSA agents, servants and employees from such claims resulting from injury, responsible for all personal medical insurance and that the participator’s family must cover all personal medical  insurance and that the participant’s family must cover all medical cost incurred. I also understand that every precaution is taken to protect the safety of each participant. I agree to emergency treatment by a physician or hospital in the event that the emergency contact listed cannot be reached.

Signature: ________________________________________________Date:_______________________________

For more information call or email:

 Hal Roberts (479) 270-1390             Allstarvolleyballclub@gmail.com